We’re back with your September Health Justice News Roundup! This month, read about changes to Medicaid, updates on reproductive and maternal health, racial disparities in childhood diabetes and an interesting array of local and timely news reports.

After a bit of a summer hiatus, we’re back with an action-packed roundup for you! Keep reading below for coverage of the latest in local health and wellness, mental health, health disparities, reproductive justice and interesting updates on the ACA in-action.

Recent Changes to the Health Plan Marketplace and Commitment to Working with Advocates Will Improve Access to Health Insurance for Thousands of Limited English Proficient New Yorkers

Albany, NY, July 17, 2014 – The New York State Department of Health, New York Lawyers for the Public Interest (NYLPI), a leading civil rights advocate for marginalized New Yorkers, and the New York Immigration Coalition (NYIC) reaffirmed the State’s ongoing commitment to improving language access and immigrant inclusion on NY State of Health, New York’s Health Exchange.

Building on the success of the Health Plan Marketplace’s first enrollment period, New York State plans to work in collaboration with NYLPI, the NYIC, and other immigrant health advocates to identify and resolve potential language barriers in accessing the Marketplace for thousands of limited English proficient (LEP) and immigrant New Yorkers.

“We appreciate the collaboration with the New York Lawyers for the Public Interest and the New York Immigration Coalition. Working together we have made a series of improvements to help ensure that LEP New Yorkers can easily access affordable, comprehensive health insurance through NY State of Health. We look forward to our continued collaboration as we move into the next open enrollment period,” said Donna Frescatore, Executive Director of NY State of Health.

Among the changes the State has made since it opened on October 1, 2013, are:

• Improved accessibility of translated materials on the Marketplace website; • Increased capacity of representatives in the customer assistance Help Line to better assist LEP consumers in multiple languages; • Translated print versions of the application in multiple languages; and • Assistance for LEP consumers who may have encountered language access barriers during the first enrollment period to complete the enrollment process.

A Spanish version of the website and online application will be available for the next enrollment period, which begins on November 15, 2014. NY State of Health is also in the process of translating notices into Spanish and additional languages. It will continue to work closely with immigrant health advocates and community-based organizations to reach immigrant and LEP communities, and identify and remedy any remaining access barriers so that all New Yorkers, regardless of language, have access to health insurance.

“We are encouraged by the real commitments that the State has made in response to the serious language access challenges of the first enrollment period,” said Shena Elrington, Director of the Health Justice Program at New York Lawyers for the Public Interest. “Providing immigrants and LEP New Yorkers access to health insurance is not only fair, but also fiscally responsible. Enrolling LEP New Yorkers in health insurance will improve their access to healthcare, and will help reduce the cost of healthcare for everyone. We look forward to partnering with the State to continue finding solutions to improve access for LEP New Yorkers and closely monitor the results.”

During the first enrollment period, over 900,000 New Yorkers enrolled in health insurance through the Marketplace—a tremendous victory. Many LEP and immigrant New Yorkers, however, still lack coverage. Prior to the launch of the first enrollment period, the Urban Institute estimated that 36 percent of potential enrollees would be LEP by the end of 2016. According to recent data released by the New York State Department of Health, 15 percent of enrollees during the first enrollment period self-reported that they prefer to speak a language other than English, which suggests that more needs to be done to make the Marketplace accessible to LEP New Yorkers.

“The New York Immigration Coalition is pleased that the State has provided important racial, ethnic, and preferred language information in its report on 2013-2014 Open Enrollment,” said Steven Choi, Executive Director of the New York Immigration Coalition (NYIC). “Our work with New York’s immigrant communities, however, shows that much work remains to ensure that immigrants can access the health care they need. We look forward to working with our members, allies, and the State to support an even more successful 2014-2015 open enrollment period.”

About New York Lawyers for the Public Interest New York Lawyers for the Public Interest (NYLPI) advances equality and civil rights, with a focus on health justice, disability rights and environmental justice, through the power of community lawyering and partnerships with the private bar. Through community lawyering, NYLPI puts its legal, policy and community organizing expertise at the service of New York City communities and individuals.

Contact for New York Lawyers for the Public Interest: Stephanie Ramirez: 212-784-5714

About the New York Immigration Coalition The New York Immigration Coalition is an umbrella policy and advocacy organization for nearly 200 groups in New York State that work with immigrants and refugees. The NYIC aims to achieve a fairer and more just society that values the contributions of immigrants and extends opportunity to all by promoting immigrants’ full civic participation, fostering their leadership, and providing a unified voice and a vehicle for collective action for New York’s diverse immigrant communities.

Welcome back! This week, read up on racial- and gender-based health disparities, reproductive justice issues ranging from abortion access to social support for parenting teens, local hospital history, and interesting developments in the field of mental health treatment and advocacy.

Health Disparities:

Reintroducing traditional wild plants into Native American diets could reduce the disproportionate rates of diabetes and obesity these communities face.

Many college grads face difficulty in accessing mental health care after graduation.

A panel has been convened to create a plan to reduce the number of mentally ill people in NYC jails. Unfortunately, this panel appears to have minimal community involvement.

The Affordable Care Act:

In states that accepted Medicaid expansion under the ACA, safety net hospitals are seeing a reduced number of uninsured patients.

In Alabama, a state that faces astounding rates of racial health disparities, residents demand expansion of the state’s Medicaid program to cover the 200,000 low-income residents not covered by the ACA.

This money could potentially go a long way toward revamping New York’s health care delivery system, which in recent years has failed to adequately meet the needs of many low-income communities across the state, particularly in Brooklyn. As a result of this funding, New York’s health system could become more coordinated, sustainable, efficient, and responsive to the needs of its diverse communities. In particular, the waiver calls for the creation of the Delivery System Reform Incentive Payment (DSRIP) program, which aims to reduce avoidable hospital use by 25% over five years by encouraging provider and community collaborations to achieve broad-based reform.

DSRIP holds tremendous promise. It creates for the first time a performing provider system (PPS) under which various providers will work together to create structural reform, break down silos in care, and collectively meet the needs of Medicaid beneficiaries. PPS explicitly includes community-based organization participation in its care model. This inclusion is critical; CBOs tend to be more connected and attuned to the dynamic and diverse health needs of the communities they serve. They provide a potentially powerful vehicle for meaningful, on-the-ground input and feedback.

While the inclusion of CBOs is encouraging, lingering questions remain about how significant their engagement in PPS will actually be. New York State, specifically the NYS Department of Health (DOH), should lay out specific mechanisms to ensure that community participation is both meaningful and sustainable. For example, DOH should require community representation in any planning meetings involving potential PPS providers, create a means through which CBOs, residents and advocates can offer input concerning DSRIP provider applications, and establish a space for continued community feedback following application approval.

In addition, the overall DSRIP process will only be successful if it is transparent and accountable. DOH has already taken great strides to explain the process, timeline, and goals in a digestible manner. DOH should maintain this level of transparency throughout the entire process.

Finally, the program needs to include a focus on decreasing racial and ethnic health disparities and addressing the social determinants of health, such as access to housing. In order to achieve its goal of a 25% reduction in avoidable hospitalizations, DRSIP will have to address health disparities head on. The program will need to collect data on race, ethnicity, disability status, and primary language of Medicaid beneficiaries and uninsured patients seeking services in order to inform reform efforts. DOH should also require DSRIP applicants to explicitly collect information on health disparities in the needs assessments they must complete to secure funding.

In the next few years, DSRIP can fulfill its potential to reform the delivery of health care across New York State and improve access to healthcare for Medicaid and uninsured beneficiaries, but only if it responds to these concerns. Otherwise, it will continue to replicate the same deficiencies of the past.

Aaaaand we’re back! We’ve got an extra special, super packed roundup for you today, because what better way to kick off summer than to get your health justice news on? Keep reading below for coverage of the latest in access to care for marginalized communities, reproductive justice, prison health, and local health and wellness initiatives.

Health Disparities:

Disparities in AIDS-related deaths in the US vs. other industrialized countries.

Local activists condemn online grocer FreshDirect’s taxpayer-funded relocation of its truck-intensive operations to the South Bronx, an area already disproportionately overburdened with truck traffic and the correlated health and environmental risks.

A No Condoms as Evidence policy–one that bans the possession of condoms as evidence of prostitution–will take effect in NYC, but unfortunately does not go far enough to protect the many communities targeted by the practice. Luckily, City Council has introduced legislation to correct this.

Check out the guest blog below from our colleagues in the Environmental Justice program here at New York Lawyers for the Public Interest and from the Alliance for a Greater New York (ALIGN). Low-income communities and communities of color disproportionately bear the burden of environmentally hazardous industries and exposure. Environmental discrimination has broad implications for the health of these communities, as evidenced by high rates of asthma in heavily polluted areas such as the South Bronx. The piece below looks at the issue of waste management in New York City and calls for a policy change that would make NYC communities cleaner and healthier.

By Justin Wood and Maya Pinto of the Transform Don’t Trash NY Coalition

Thanks to new programs from New York City’s Department of Sanitation, many New Yorkers are beginning to recycle and compost more of the trash we generate in our homes and apartments.

But have you ever wondered what happens to the trash you throw out at work, or what happens to food scraps every time you eat a meal at a restaurant? NYC businesses generate a staggering 5.5 million tons of garbage per year – and almost 75% of it ends up buried in landfills or burned in incinerators.[1]

Not only do these outmoded disposal practices contribute significantly to greenhouse gas emissions; our giant, chaotic, and inefficient private-sector waste system also contributes to chronic health crises for thousands of New Yorkers.

Our commercial and restaurant waste is picked up by any of over 230 private haulers, which operate more than 4,000 trucks in NYC. Because these companies constantly compete for customers, they operate inefficient, overlapping truck routes and send unnecessary diesel emissions into our air – releasing dozens of nasty pollutants linked to premature deaths, heart attacks, asthma, and other serious ailments. Commercial garbage truck drivers face pressure to complete their collection routes each night as quickly as possible – leading many to engage in speeding, illegal turns, and reverse moves on one-way streets, endangering pedestrians and cyclists.[2] In fact, better regulation of commercial waste trucks may be essential to achieving the safe streets called for in the mayor’s new Vision Zero plan: studies have found that, per mile, commercial garbage trucks cause more cyclist fatalities than any other vehicle.

2) Our waste is disproportionately handled in low-income communities and communities of color.

The vast majority of NYC waste is carted by heavy collection trucks to transfer stations before ultimately being hauled away from the transfer stations in still more trucks. The majority of these transfer facilities are located in just three outer-borough neighborhoods – the South Bronx, North Brooklyn, and Jamaica, Queens – which are home to more than half a million people, most of whom are low-income and of color, and many of whom suffer from elevated rates of asthma and other chronic health problems.

“Waste-to-Energy” Incinerators also emit greenhouse gases and toxins such as dioxin and mercury, which are associated with cancer and other health impacts common to overburdened communities. Hundreds of thousands of tons of NYC waste are trucked to an incineration plant in Newark’s Ironbound neighborhood, which is burdened by a high rate of childhood asthma.

3) Workers Face Serious Health Hazards

The solid waste industry is among the deadliest in the nation for workers, and waste workers face daily hazards like exposure to poisons, toxins, rodents, infectious diseases, and diesel fumes.

While collecting garbage is inherently difficult, dirty work, not all workers are treated equally. City workers collecting waste from residences have good health benefits, union representation, and pension plans. In contrast, private hauler workers who collect waste from offices, restaurants, and other businesses suffer from an under-regulated “race to the bottom” in which wage and safety standards are sacrificed for the bottom line. Moreover, commercial waste workers are disproportionately people of color who earn significantly less than their white counterparts.[3]

Thankfully, our city has the opportunity to set policies that solve these problems. The City can enact high-road labor and environmental standards and establish accountability mechanisms in the commercial waste industry by adopting an approach to solid waste management that is increasingly being used in cities across the country.

Cities including Los Angeles, San Jose, and Seattle have adopted innovative approaches to waste management in which haulers submit bids for the exclusive right to collect waste in geographic zones designated by the city. Haulers are selected based on factors such as fair prices for customers, the hauler’s ability to meet city recycling goals, and commitment to fair wages and health benefits for workers.

The results are promising: San Jose has seen its business recycling and composting rates jump rapidly from 23% to 71% after choosing an innovative hauling company to collect all commercial waste. Los Angeles just adopted similar legislation and anticipates that its new system will greatly boost recycling and composting rates while reducing inefficient truck routes throughout the city.

If New York City follows suit, we could eliminate over 5 million diesel truck miles every year on our streets, improve the health and wellness of our most vulnerable residents, prevent 2.5 million tons of waste per year from being landfilled or incinerated, and create over 15,000 quality local jobs by recycling our commercial waste into useful products.

[1]Recent data from an unpublished study commissioned by DSNY (acquired by TDTNY through a FOIL request) show that our commercial waste problem is worse than previously understood. NYC previously estimated commercial waste generation at 3 million tons per year with a 31% recycling/diversion rate. New estimates are 5.1 million TPY with only a 26% diversion rate. Source: Halcrow Engineers, “New York City Comprehensive Commercial Waste System Analysis and Study,” submitted August, 2012.

[2] After directly observing more than 125 different NYC blocks at night, DSNY’s consultants find that these illegal time-saving maneuvers were common. Source: “New York City Comprehensive Commercial Waste System Analysis and Study,” p. 3-15.

[3] EEO tabulations of Census data analyzed by ALIGN show that while 12% of white workers in the waste industry earn less than $35,000/year, a majority of Latino workers and 75% of non-citizen workers earn less than $35,000/year. See Transform Don’t Trash NYC p. 12.